Ok, so it's been just over a year since I got my fissure and it hasn't healed. I was using nitro .2% last year and by December it's effects were starting to wear off, I didn't mind the headaches because that's how I knew it was working. My GI prescribed me Diltiazem 2% and that has been working great, reallly does loosen everything up down there. How long can I use the Diltiazem before I start to build up a tolerance or dependency? I feel like things are getting slightly worse than they were about a month ago, more tightness anyways which is the root of the problem. Also, is using ointments like Diltiazem and Nitro for extended periods of time comparable to having surgery? I really want to avoid surgery at all costs. End of blahg.

Hey jman, I've recently been prescribed Diltiazem 2% and was told to use it for 6-8 weeks max, don't know whether it's effects are greatly diminished after that time or not, I got my ointment in a tub that expires in just over a month, so it doesn't seem to have a great shelf life, do you apply the ointment internally or externally?

There is really no limit in time of how long you can use creams - it is just a matter of how long you will be willing to live "of creams" :roll: . Some people do develop sensitivity to them since they are vasodilatory (enlarge the capillaries) and that can cause burning and itching. Some people develop allergy. But, as long as you do not have problems and see benefits - than there is no reason you can not use them. I do not believe one can develop tolerance so fast - those meds are used for hypertension after all and people use them for decades with the same effect !
Now - Nitro is very unstable and it looses potency fast - a month is about "it". Dilitazem has longer potency.
Comparing creams to surgery is not possible IMO. LIS gives bigger and permanent release of spasms. I used both kind of creams and they never gave me a relaxation as big as LIS did . Now - if somebody does not have SUPER tight sphincter and cream can relax it enough to heal the fissure- than creams could have 100 % success - BUT it will happen usually in 6-8 week period, 12 week max., in rare cases after 6 mos (according to all papers I read). If one has super-tight sphincter - than LIS is usually the only permanent solution.
Best of luck !!!!

That's true Fissy, how long can we keep going just off creams alone, personally I would like LIS right now!! but my CRS wants to try Diltiazem as a last resort, so I guess after my session on the ointment it's surgery time, kinda looks like a win win situation, but as good as that sounds it doesn't quite account for all the years of suffering i've endured to get to this stage, it's been a very long winding road of seeing my GP lots of times and 3 different CRS's just to get where I am now.
I don't think my sphincter is super tight but there is definitely some spasms after BM and they also occur throughout the day, so it's anyones guess as to whether the ointment will be effective or not, i'm remaining optimistic for the time being, give it time to work.
Thanks for your support

Steve,
I know a couple of people who developed a sensitivity to Diliatzem after a time (Tabby and Val). But everyone is different. They developed horrible itching if I recall correctly. Good luck!

Hi cheryl,
Hope I don't get the itching, although i've had a fair amount of itching before using any ointments and it drove me nuts LOL, time will surely tell whether I develop a sensitivity to Diltiazem, fingers, legs and arms crossed!

Hey jman, sorry to hear you're still having problems. I've been using nitro and nifedipine for maybe 9 months now and am also trying to dodge surgery if I can.
I'm with Fiss, I don't think the effects of the ointments should wear off that quickly. As with all drugs, I can imagine some level of tolerance developing, but it should be relatively minimal. The side effects like throbbing headaches from nitro should go away after using it for a while though.
What Fiss said about nitro is definitely true. It loses its potency very fast, even faster if it's exposed to air or light (its chemical instability is why it's used in explosives). I found this one out the hard way. I've had some butt problems return recently and just realized a few days ago that I've been using nitro ointment from back in September 2009. I got some fresh stuff and it makes a pretty big difference -- I could immediately feel the side effects like the headache and it also relaxed the sphincter a lot more, neither of which were true with the old ointment. Maybe your nitro was just dated and losing efficacy?
Both nifedipine and diltiazem are supposed to last much longer. Unfortunately neither one replaces surgery in severe cases though :(

I also want to add that most medical trails that were done with creams and botox were done on acute fissures that just turned chronic - which means - the people involved in trails had fissure longer than 6 weeks but not for "years" !!!!! So - yes, their "success" rate is that big in the studies due to the fissures not being very long in the chronic state and not forming a scar tissue that prevents healing.
Talking about "skewing" results
BUT - now every CRS will try creams and Botox before the LIS as one size fits all approach AND because insurance definitely asks that of them !!!! First they have to try cheaper treatment - it is always the case with ANY condition one has .
If you have joint pain - they will first put you on Advil and Alive and if that fails THAN you will get a prescription and probably the cheapest drug around that is in your insurance "book" and of course a generic . THAN, if you have problems with that drug - than you will get a better one and MAYBE in the 5th trail get a brand name or the "newest kid on the block" !!!!
So ...yeah ... Fissy hates insurance and doctors who "feed" each others incompetence, greed and make profit of people's suffering instead of offering the best course of action and the best medications available at the first visit May the "cosmos" put them where they belong at the end of "their journey" MUAAAAHAHAHHAAAAAAAAAA !!!!

This is so true! The first 3-4 visits to a doctor are absolutely worthless. You have to complain about the same damn thing over and over again before anything meaningful gets done. It's sad but true. Even if your doctor thinks your fissure needs BOTOX or LIS to treat, you will never get it as an option the first or second time because of the associated cost. Instead you'll be given cream #1 to try, then cream #2, then an increased dose of whatever didn't work before, and after you've suffered for a while and the condition has gotten worse, options that should have been available in the first place will finally begin to open up. It's a sad pattern and has nothing to do with good medical are and everything to do with helping insurance save money -- which it doesn't even do in most cases because all they end up doing in the long run is paying more for your doctor's visits!!!
I've seen doctors for various things too and it's been like that every single time. In fact last year I had 100+ medical claims which could've been MUCH fewer if doctors had just ordered the right tests the first time. But nope every time, the first few visits I was just sent for blood tests (because they're cheap) and never got anything of real diagnostic value like a MRI or CT scan until after I complained multiple times about the same exact problem.
The silver lining is that I've long since realized that doctors have no idea what other doctors have or haven't done for you. So now before I go in, I try to research all the possible options I expect to come up, and if there's something that I know for sure is going to be worthless, I just make sure I have a reason handy as to why it won't work :) If the guy says to try some ibuprofen, I just say that I've already tried and it didn't do squat, so please save us both some time and give me something that'll work already :) Pretty sad that patients have to resort to stuff like this but sometimes you have to take a stand against getting the runaround from a medical system that doesn't care about you at all.

I think some docs care, NG! (I have 2 that do, I think.) But I agree the system is a pain in the #$#$#9!!!! Smart thinking on your part in being proactive!!